Memantine in patients with frontotemporal lobar degeneration: a multicentre, randomised, double-blind, placebo-controlled trial - PubMed (original) (raw)
Randomized Controlled Trial
doi: 10.1016/S1474-4422(12)70320-4. Epub 2013 Jan 2.
David S Knopman, Daniel I Kaufer, Murray Grossman, Chiadi Onyike, Neill Graf-Radford, Mario Mendez, Diana Kerwin, Alan Lerner, Chuang-Kuo Wu, Mary Koestler, Jill Shapira, Kathryn Sullivan, Kristen Klepac, Kristine Lipowski, Jerin Ullah, Scott Fields, Joel H Kramer, Jennifer Merrilees, John Neuhaus, M Marsel Mesulam, Bruce L Miller
Affiliations
- PMID: 23290598
- PMCID: PMC3756890
- DOI: 10.1016/S1474-4422(12)70320-4
Randomized Controlled Trial
Memantine in patients with frontotemporal lobar degeneration: a multicentre, randomised, double-blind, placebo-controlled trial
Adam L Boxer et al. Lancet Neurol. 2013 Feb.
Abstract
Background: Memantine has been used off-label to treat frontotemporal lobar degeneration (FTD). A previous 26-week open-label study suggested a transient, modest benefit on neuropsychiatric symptoms as measured by the neuropsychiatric inventory (NPI). We aimed to determine whether memantine is an effective treatment for FTD.
Methods: We did a randomised, parallel group, double-blind, placebo-controlled trial of 20 mg memantine taken orally daily for 26 weeks in patients with FTD. Participants met Neary criteria for behavioural variant FTD (bvFTD) or semantic dementia and had characteristic brain atrophy. Use of acetylcholinesterase inhibitors was prohibited. Individuals were randomly assigned to receive either memantine or matched placebo tablets (1:1) in blocks of two and four patients. All patients and study personnel were masked to treatment assignment. Primary endpoints were the change in total NPI score and clinical global impression of change (CGIC) score after 26 weeks and were analysed by intention to treat. This study is registered with Clinicaltrials.gov, number NCT00545974.
Findings: Of 100 patients screened, 81 were randomly assigned to receive memantine (39 patients) or placebo (42 patients). Five (6%) patients discontinued, and 76 completed the 26-week treatment. Enrolment numbers were lower than planned because of many patients' preference to take memantine or cholinesterase inhibitors off-label rather than participate in a clinical trial. Memantine treatment had no effect on either the NPI (mean difference 2·2, 95% CI -3·9 to 8·3, p=0·47) or CGIC (mean difference 0·0, -0·4 to 0·4, p=0·90) after 26 weeks of treatment. Memantine was generally well tolerated; however, patients in the memantine group had more frequent cognitive adverse events (six patients) than those in the placebo group (one).
Interpretation: Memantine treatment showed no benefit in patients with FTD. These data do not support memantine use in FTD.
Funding: Forest Research Institute.
Copyright © 2013 Elsevier Ltd. All rights reserved.
Figures
Figure 1
Patient flow diagram.
Figure 2. Primary outcome variables
(A) Change from baseline of total Neuropsychiatric Inventory (NPI) scores from the intent to treat population are shown with p values for a paired t test at each study visit. In the repeated measures analysis there was no group difference (p = 0.39). (B) Clinician’s Global Impression of Change (CGIC) values are shown at week 26 for n = 76 subjects who completed this visit. Only improved = “slightly improved (3)”, no change = “no change (4)” and Worsened = “slightly worsened (5)” are shown since no other values were recorded. Using a Mann Whitney test there was no difference in CGIC distributions (p = 0.90).
Figure 3. Functional rating scales
(A) Change from baseline Functional Activities Questionnaire (FAQ) scores in the intent to treat population. (B) Change from baseline in Clinical Dementia Rating sum of boxes (CDR-SB-FTD) scores.
Figure 4. Neuropsychological tests
(A) Change from baseline modified Boston Naming Test (BNT). (B) Change from baseline Digit Symbol Substitution Test scores.
Comment in
- Hope abandoned: memantine therapy in frontotemporal dementia.
Hodges JR. Hodges JR. Lancet Neurol. 2013 Feb;12(2):121-3. doi: 10.1016/S1474-4422(13)70001-2. Epub 2013 Jan 8. Lancet Neurol. 2013. PMID: 23305744 No abstract available.
Similar articles
- An open-label study of memantine treatment in 3 subtypes of frontotemporal lobar degeneration.
Boxer AL, Lipton AM, Womack K, Merrilees J, Neuhaus J, Pavlic D, Gandhi A, Red D, Martin-Cook K, Svetlik D, Miller BL. Boxer AL, et al. Alzheimer Dis Assoc Disord. 2009 Jul-Sep;23(3):211-7. doi: 10.1097/WAD.0b013e318197852f. Alzheimer Dis Assoc Disord. 2009. PMID: 19812461 Free PMC article. Clinical Trial. - Memantine in patients with Parkinson's disease dementia or dementia with Lewy bodies: a double-blind, placebo-controlled, multicentre trial.
Aarsland D, Ballard C, Walker Z, Bostrom F, Alves G, Kossakowski K, Leroi I, Pozo-Rodriguez F, Minthon L, Londos E. Aarsland D, et al. Lancet Neurol. 2009 Jul;8(7):613-8. doi: 10.1016/S1474-4422(09)70146-2. Epub 2009 Jun 10. Lancet Neurol. 2009. PMID: 19520613 Clinical Trial. - Efficacy of memantine on neuropsychiatric symptoms associated with the severity of behavioral variant frontotemporal dementia: A six-month, open-label, self-controlled clinical trial.
Li P, Quan W, Zhou YY, Wang Y, Zhang HH, Liu S. Li P, et al. Exp Ther Med. 2016 Jul;12(1):492-498. doi: 10.3892/etm.2016.3284. Epub 2016 Apr 20. Exp Ther Med. 2016. PMID: 27347084 Free PMC article. - Memantine for dementia.
Areosa SA, Sherriff F. Areosa SA, et al. Cochrane Database Syst Rev. 2003;(3):CD003154. doi: 10.1002/14651858.CD003154. Cochrane Database Syst Rev. 2003. PMID: 12917950 Updated. Review. - Memantine for dementia.
Areosa SA, Sherriff F. Areosa SA, et al. Cochrane Database Syst Rev. 2003;(1):CD003154. doi: 10.1002/14651858.CD003154. Cochrane Database Syst Rev. 2003. PMID: 12535459 Updated. Review.
Cited by
- Changes in Digital Speech Measures in Asymptomatic Carriers of Pathogenic Variants Associated With Frontotemporal Degeneration.
Nevler N, Cho S, Cousins KAQ, Ash S, Olm CA, Shellikeri S, Agmon G, Gonzalez-Recober C, Xie SX, Barker MS, Manoochehri M, Mcmillan CT, Irwin DJ, Massimo L, Dratch L, Cheran G, Huey ED, Cosentino SA, Van Deerlin VM, Liberman MY, Grossman M. Nevler N, et al. Neurology. 2024 Jan 23;102(2):e207926. doi: 10.1212/WNL.0000000000207926. Epub 2023 Dec 20. Neurology. 2024. PMID: 38165329 - Transcranial direct current stimulation in semantic variant of primary progressive aphasia: a state-of-the-art review.
Norata D, Motolese F, Magliozzi A, Pilato F, Di Lazzaro V, Luzzi S, Capone F. Norata D, et al. Front Hum Neurosci. 2023 Nov 8;17:1219737. doi: 10.3389/fnhum.2023.1219737. eCollection 2023. Front Hum Neurosci. 2023. PMID: 38021245 Free PMC article. - Frontotemporal lobar degeneration.
Grossman M, Seeley WW, Boxer AL, Hillis AE, Knopman DS, Ljubenov PA, Miller B, Piguet O, Rademakers R, Whitwell JL, Zetterberg H, van Swieten JC. Grossman M, et al. Nat Rev Dis Primers. 2023 Aug 10;9(1):40. doi: 10.1038/s41572-023-00447-0. Nat Rev Dis Primers. 2023. PMID: 37563165 Review. - When words first fail: Predicting the emergence of primary progressive aphasia variants from unclassifiable anomic performance in early disease.
Stockbridge MD, Tippett DC, Breining BL, Hillis AE. Stockbridge MD, et al. Aphasiology. 2023;37(8):1173-1185. doi: 10.1080/02687038.2022.2084706. Epub 2022 Jun 7. Aphasiology. 2023. PMID: 37377938 Free PMC article. - Iranian clinical practice guideline for amyotrophic lateral sclerosis.
Boostani R, Olfati N, Shamshiri H, Salimi Z, Fatehi F, Hedjazi SA, Fakharian A, Ghasemi M, Okhovat AA, Basiri K, Haghi Ashtiani B, Ansari B, Raissi GR, Khatoonabadi SA, Sarraf P, Movahed S, Panahi A, Ziaadini B, Yazdchi M, Bakhtiyari J, Nafissi S. Boostani R, et al. Front Neurol. 2023 Jun 2;14:1154579. doi: 10.3389/fneur.2023.1154579. eCollection 2023. Front Neurol. 2023. PMID: 37333000 Free PMC article. Review.
References
- Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology. 1998;51:1546–1554. - PubMed
- Rosen HJ, Allison SC, Ogar JM, et al. Behavioral features in semantic dementia vs other forms of progressive aphasias. Neurology. 2006;67:1752–1756. - PubMed
Publication types
MeSH terms
Substances
Grants and funding
- P30 AG013854/AG/NIA NIH HHS/United States
- P50 AG023501/AG/NIA NIH HHS/United States
- R01 DC008552/DC/NIDCD NIH HHS/United States
- P50AG023501/AG/NIA NIH HHS/United States
- R01 AG038791/AG/NIA NIH HHS/United States
- R01AG031278/AG/NIA NIH HHS/United States
- P50 AG1657303/AG/NIA NIH HHS/United States
- P01 AG019724/AG/NIA NIH HHS/United States
- R01AG038791/AG/NIA NIH HHS/United States
- P01AG019724/AG/NIA NIH HHS/United States
- UL1 TR000150/TR/NCATS NIH HHS/United States
- R01 AG031278/AG/NIA NIH HHS/United States
LinkOut - more resources
Full Text Sources
Other Literature Sources
Miscellaneous